Thursday, January 26, 2006

Going Drug Free

Well, my last refill of Paroxetine (generic for Paxil) has run out, and I haven't made an appointment to get a refill. I'm still trying to decide if I ought to, or if I want to. Truth to tell I'm avoiding a doctor's appointment I know I ought to get (I'm due for a cholesterol check too), because I can't bloody make up my mind whether I want to continue taking anti-depressants or not.

I went on Paroxetine just about two years ago. My wonderful, sane, primary-care physician at that time gave me enough support and just the right amount of freedom to let me say OK, and give it a try. I had gone to him because one day, that to me felt like any other day, I had run into an on-line depression test, and being the little test-hound that I am, had taken it.

To my shock, I rated 30 on a scale that only went to 33. The advice was "Make an immediate appointment with your mental health professional. If necessary call a hotline." I hunted down a good dozen different tests for depression. The results were universal. The best rating I got was moderately depressed. The 30 out of 33 was not the worst. What made this so shocking to me, was that was how I rated on an ordinary day. Not particularly bad, not particularly good - just a day. I had had far worse days in my life many times. If this was how my ordinary day looked, how would I rate on a truly bad day. How would I have rated in college, when suicide ideation was practically a way of life?

For the first time since college, I felt as if I might be crazy. How could my normal state of being be so far from healthy? So I went to my doctor (thank God I had switched from my previous PCP, who was just plain weird), and he heard me out, asked me some serious questions, and made me a proposal.

I was - he thought - probably depressed, with a dollop of anxiety thrown in for good measure. It felt normal to me, simply because I had been that way for so long. (At that point 26 years!) At the same time he took my aversion to unnecessary drug-taking seriously. So he gave me a four-week course of Paroxetine - no prescription, just sample packs - and made an appointment that day, for me to come back in four weeks for re-evaluation. (Note to physicians - have your patients make their return appointments on their way out the door. Saves lots of dithering on their part later.) If I had side-effects, or the anti-depressant didn't help me significantly, we'd talk about other options. If it did help, then we would talk about a prescription.

I cannot describe what happened about two weeks later when the Paroxetine kicked in. It wasn't gradual, and it wasn't mistakeable. I was coming home from dropping the littlest munchkin off at pre-school, and I suddenly felt happy. It wasn't a sensation I was used to. It was literally stunning. I had felt satisfaction, or joy, or humorous before, but I could not recall being simply happy - ever. I went and took a walk on a brisk, windy day for the sheer joy of stretching my muscles and feeling the wind. I floated through that day - was that what other people actually felt like? It seemed too good to be actually true.

And it was - sort of. That day was a ten on the happiness scale. I didn't stay on a constant ten after the Paroxetine kicked in, that would take different (and illegal) drugs. But I was consistantly happier, more relaxed, less anxious. I got more done. I slept well for the first time in my life (yes my entire life, I was a child insomniac.). By the time I came back for my second appointment I was more than ready for a prescription.

My PCP at that time gave me a suggested schedule. Given the duration of my depression, he felt that it was likely I would need lifetime anti-depressants, but he didn't want to leap to that immediately. So he suggested that I should take Paroxetine for six months, then stop for a month to exaluate. If my depression returned, I would go back on it, this time for two years. That would be followed by another break and evaluation. If after two and a half years, I still needed an anti-depressant to have a normal scale of emotion, then he would make the prescription lifetime. It seemed (and seems) a sensible solution to me, and one I agreed to.

And then we moved over 1000 miles.

At the end of my initial six month prescription I waited a month, then went to my new PCP, in my new state. We discussed things, and I went back on Paroxetine. I felt normal emotionally, but my sleeping was disturbed again. When the drug levels in my bloodstream ramped back up, I realized that I had slipped back emotionally as well, but that depression still reads as "normal" on my internal meters. Unfortunately my new PCP was someone, who while nice, and perfectly acceptable in all other ways, didn't read as safe to my emotional self, and thereby wasn't going to hear the full confession. (To be fair to the perfectly nice and competant man, PCP #1 is the only doctor in a lifetime of them that has felt safe in that way.) Which leaves me to try to sort things out myself.

Now this second prescription has run out. To complicate things even more, PCP #2 has left the practice, so when I go to my next appointment I'll be dealing with a stranger. It's been about 2 weeks since I took my last pill, and I'm still completely undecided if I want to continue taking them or not. I feel normal - but I always feel normal. I'm not sleeping particularly well, but my life is a busy mess at the moment, so I don't know if it's the lack of Paroxetine or just life that's doing it. I can't trust my new PCP to sort out if I'm sliding into depression or not because I cover so damn well when I'm dealing with other people. I have never, ever had someone diagnose me as depressed based on my behavior or self-description except for PCP #1. That includes the therapist at college when I was playing with knives at night. She told me that I was one of the sanest people she'd ever met - that's how well I cover in person. So I'm left to decide on my own to make a decision about going on an anti-depressant for life. And I don't know what to do.

I hate the idea of taking a pill every day for the rest of my life. I also hate the idea of spending the rest of my life in a fog of depression, anxiety, and self-criticism when I don't have to. I desperately, desperately wish PCP #1 were available because I could trust his judgement as to whether the Paroxetine is something I need or not. There's no one else who can give me a view both accurate and unclouded. My husband is already on three drugs a day, every day, doesn't mind, doesn't see why I should. The Paroxetine doesn't cause me any side effects, why not take it? My in-laws feel similarly. My own parents haven't gotten over the shock I needed an anti-depressant in the first place, and refuse to consider the idea I might need one for life. I think they feel it reflects badly on their parenting. None of my really close friends live near enough to see me more than once or twice a year - they're in no position to judge my state of mind, and it would be unfair to ask them to.

So I've come here, and I'm rambling on to the world at large at 1am because I don't know what to do. Whenever I overcome my inertia and make my next doctor's appointment, what I choose to do and say, and how I choose to present myself is going to decide this. And I can't even decide if the obsessing I'm doing is evidence for a recurrence of depression and anxiety, or simply reflective of how seriously I'm taking the decision.

2 comments:

I am not a mental health care professional, and don't claim to be an expert, so take what I am about to say as opinion only. First off, those drugs can give even a non-depressed person an emotional boost. Just because you felt happy after taking them, doesn't prove you were depressed in the first place. Secondly, I wouldn't go to a regular medical doctor for an evaluation of depression. They simply are not qualified to deal with emotional issues. Third, if all you are doing is taking drugs, you are treating the symptoms, not the disease. You need to find someone who will help you dig down into yourself and find out WHY you are depressed. If you are depressed because of some chemical or hormonal imbalance, you would need blood tests and stuff know for sure. A simple chat in the doctor's office isn't sufficient to determine that.

Thanks for the concern, Becky. Taking drugs is not all I do/have done for depression. Even without the Paroxetine there's no doubt that I am much, much better than I was a decade ago. I am extremely wary of going to a psychiatrist/psychologist sight unseen due to some less than stellar experiences, though I would be open to one I whose judgement I had reason to trust. The general idea is that I spent 26 years of my life being depressed, and other than a couple of particularly spectacular moments - simply didn't notice. I thought that the way I thought was normal. From what research I've done, and what PCP#1 had to say there's a good chance that my neurochemistry will simply never bounce back after so long a period of depression. (I was a neuropharmacological research assistant, so I know how to check this stuff out, I just don't have the perspective to apply it accurately to myself.)